Weight Change and the Onset of Cardiovascular Diseases: Emulating Trials Using Electronic Health Records

Katsoulis, Michail; Stavola, Bianca De; Díaz-Ordaz, Karla; Gomes, Manuel; Lai, Alvina G.; Λάγιου, Παγώνα; Wannamethee, Goya; Tsilidis, Konstantinos K.; Lumbers, R Thomas; Denaxas, Spiros; Banerjee, Amitava; Parisinos, Constantinos; Batterham, Rachel L.; Patel, Riyaz; Langenberg, Claudia; Hemingway, Harry

doi:10.1097/ede.0000000000001393

Cited by 24 publications

(34 citation statements)

References 30 publications

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“…25 Additionally, the increasing trends in BMI are combined with an increasing prevalence of diabetes in young adults. 10 From the perspective of both obesity prevention and health in young adults, it is important to address the challenge that, with the exception of pregnancy complications, most of the adverse health consequences of obesity and weight gain (including severe COVID-19, cardiovascular disease, and type 2 diabetes) 26 occur decades later, in middle-age and older age. Finally, repeated lockdowns during the COVID-19 pandemic have profoundly reduced the amount of physical activity and energy expenditure in young adults, which has had adverse effects on weight gain.…”

Section: Discussionmentioning

confidence: 99%

Identifying adults at high-risk for change in weight and BMI in England: a longitudinal, large-scale, population-based cohort study using electronic health records

Katsoulis

Lai

Díaz-Ordaz

et al. 2021

The Lancet Diabetes & Endocrinology

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Background Targeted obesity prevention policies would benefit from the identification of population groups with the highest risk of weight gain. The relative importance of adult age, sex, ethnicity, geographical region, and degree of social deprivation on weight gain is not known. We aimed to identify high-risk groups for changes in weight and BMI using electronic health records (EHR). MethodsIn this longitudinal, population-based cohort study we used linked EHR data from 400 primary care practices (via the Clinical Practice Research Datalink) in England, accessed via the CALIBER programme. Eligible participants were aged 18-74 years, were registered at a general practice clinic, and had BMI and weight measurements recorded between Jan 1, 1998, and June 30, 2016, during the period when they had eligible linked data with at least 1 year of follow-up time. We calculated longitudinal changes in BMI over 1, 5, and 10 years, and investigated the absolute risk and odds ratios (ORs) of transitioning between BMI categories (underweight, normal weight, overweight, obesity class 1 and 2, and severe obesity [class 3]), as defined by WHO. The associations of demographic factors with BMI transitions were estimated by use of logistic regression analysis, adjusting for baseline BMI, family history of cardiovascular disease, use of diuretics, and prevalent chronic conditions. Findings We included 2 092 260 eligible individuals with more than 9 million BMI measurements in our study. Young adult age was the strongest risk factor for weight gain at 1, 5, and 10 years of follow-up. Compared with the oldest age group (65-74 years), adults in the youngest age group (18-24 years) had the highest OR (4•22 [95% CI 3•86-4•62]) and greatest absolute risk (37% vs 24%) of transitioning from normal weight to overweight or obesity at 10 years. Likewise, adults in the youngest age group with overweight or obesity at baseline were also at highest risk to transition to a higher BMI category; OR 4•60 (4•06-5•22) and absolute risk (42% vs 18%) of transitioning from overweight to class 1 and 2 obesity, and OR 5•87 (5•23-6•59) and absolute risk (22% vs 5%) of transitioning from class 1 and 2 obesity to class 3 obesity. Other demographic factors were consistently less strongly associated with these transitions; for example, the OR of transitioning from normal weight to overweight or obesity in people living in the most socially deprived versus least deprived areas was 1•23 (1•18-1•27), for men versus women was 1•12 (1•08-1•16), and for Black individuals versus White individuals was 1•13 (1•04-1•24). We provide an open access online risk calculator, and present high-resolution obesity risk charts over a 1-year, 5-year, and 10-year follow-up period.Interpretation A radical shift in policy is required to focus on individuals at the highest risk of weight gain (ie, young adults aged 18-24 years) for individual-level and population-level prevention of obesity and its long-term consequences for health and health care.

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Section: Discussionmentioning

confidence: 99%

Identifying adults at high-risk for change in weight and BMI in England: a longitudinal, large-scale, population-based cohort study using electronic health records

Katsoulis

Lai

Díaz-Ordaz

et al. 2021

The Lancet Diabetes & Endocrinology

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“…The dyspnoeic effects on individuals could potentially promote a more sedentary lifestyle, in turn increasing the cardiovascular risk of such a population. Weight gain and a decreased level of fitness can arise as a subsequent consequence of such lifestyles, thus highlighting the importance of understanding the relationship between dyspnoea and the use of N95 respirators [ 26 ].…”

Section: Reviewmentioning

confidence: 99%

A Systematic Review of Whether the Use of N95 Respirator Masks Decreases the Incidence of Cardiovascular Disease in the General Population

Khan¹,

Khan²,

Perry³

et al. 2022

Cureus

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The usage of masks such as the N95 has increased exponentially worldwide. With the ever-increasing global rates of cardiovascular disease, it is vital that preventative measures are adopted to help tackle this crisis. N95 masks have been promoted as health prevention odysseys in the battle against viruses such as COVID-19. A systematic review was conducted on whether the N95 masks could help improve our cardiovascular health. Our data sources included PubMed, Medline and Scopus. Eleven studies met the eligibility criteria to be included in the review. N95 mask usage led to increased reports of dyspnoea, however, no significant effect was seen on blood pressure. N95 masks also showed improvement in aortic parameters. While encouraging results were yielded, further focussed studies on the use of N95 masks and the effect on various cardiovascular parameters would help strengthen the association.

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“…Stevens et al [ 11 ] found that earlier weight gain over a long interval was associated with increased risks of CHD and ischemic stroke, whereas later, weight loss over a shorter interval was associated with increased immediate CHD and stroke risk, when compared with weight maintenance. Katsoulis et al [ 22 ] estimated the eﬀect of 2-year weight change interventions on 7-year risk of CVD, and results found that weight maintenance group had a lower CVD risk compared with the weight gain and the weight-loss group among normal-weight individuals. While, among individuals with overweight, the weight loss and weight gain groups had a slightly higher CVD risk compared with weight maintenance.…”

Section: Discussionmentioning

confidence: 99%

Weight Change over 4 Years and Risk of Cardiovascular Diseases in China: The China Health and Retirement Longitudinal Study

Zheng

2022

Obes Facts

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Introduction: Previous studies had reported the impact of weight changes in middle age on the incidence of cardiovascular disease (CVD), but the results were inconsistent. In present study, we aimed to investigated the impact of a 4-year weight change on the risk of CVD in middle-aged and elderly Chinese individuals. Methods: Using nationally representative data from the China Health and Retirement Longitudinal Study, 7,530 participants (age: 58.2 ± 8.9 years) were included. Weight change was calculated by subtracting weight at baseline from that at 4-year follow-up. Weight change over 4 years was divided into five categories (loss ≥5 kg; loss 2–5 kg; stable (change ≤ 2 kg); gain 2–5 kg; and gain ≥5 kg). Results: During the follow-up period, a total of 758 respondents experienced CVD (including 319 stroke and 477 cardiac events). The multivariable ORs of CVD for gain ≥5 kg compared to stable weight (change ≤2 kg) was 1.50 (95% CI, 1.14–1.97) versus 1.41(1.09-1.83) for losing ≥5 kg. Multivariable-adjusted logistic regression model with restricted cubic splines showed a U-shaped association between weight change and the risk of CVD (p for nonlinearity <0.001). The significant associations did not change in subgroup and sensitivity analysis. Weight change was also associated with higher risk of stroke and cardiac events. Conclusion: Weight changes (weight gain or loss more than 5kg) during middle age was associated with an increased risk of CVD in middle-aged and elderly Chinese individuals.

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Weight Change and the Onset of Cardiovascular Diseases: Emulating Trials Using Electronic Health Records

Cited by 24 publications

References 30 publications

Identifying adults at high-risk for change in weight and BMI in England: a longitudinal, large-scale, population-based cohort study using electronic health records

Identifying adults at high-risk for change in weight and BMI in England: a longitudinal, large-scale, population-based cohort study using electronic health records

A Systematic Review of Whether the Use of N95 Respirator Masks Decreases the Incidence of Cardiovascular Disease in the General Population

Weight Change over 4 Years and Risk of Cardiovascular Diseases in China: The China Health and Retirement Longitudinal Study

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